Provider Demographics
NPI:1336319839
Name:NEWTON, DEANNE ELISE (MSPAS, PA-C, CN)
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:ELISE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:MSPAS, PA-C, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 SOUTH BROADWAY
Mailing Address - Street 2:APT 5
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-540-9900
Mailing Address - Fax:
Practice Address - Street 1:1831 ORANGE AVE STE C
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-574-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001135133N00000X
CAPA 14830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689608937Medicare NSC